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Peds Neuro > Pediatric Evaluation of Ventilation and Respiration > Flashcards

Pediatric Evaluation of Ventilation and Respiration Flashcards

1
Q

What should be evaluated in all patients?

A

breathing mechanics

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2
Q

Which systems are going to most impact respiration?

A
  • cardiovascular/pulmonary
  • musculoskeletal
  • neuromuscular
  • integumentary
  • GI
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3
Q

What always wins?

A

breathing !!!

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4
Q

Categories to ask about with history

A
  • feeding
  • sleeping
  • fatigue levels
  • overall fitness
  • bowel morvmenets
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5
Q

Sxs neonate (0-1mo) is having difficulty breathing

A
  • facial expression, body movements, crying, changes in heart rate, respiratory rate, BP, SaO2, vagal tone, palmar sweating
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6
Q

Sxs Infant (1mo-1yr) is having difficulty breathing

A

startles, hiccups, gasping, tremors, twitching, yawning, sneezing

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7
Q

Sxs Toddler (1-2yr) is having difficulty breathing

A

feeding difficulties, irritability, increased crying, grunting, breathing holding, crying that cant be comforted, facial expression (burrowed brow, wrinkled forehead, closed eyes, angry appearance), sleep changes, body movements, clinging to whoever holds them, not moving

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8
Q

Sxs Child is having difficulty breathing

A
  • acting out behaviors, anger problems, stomach aches or headaches, decreased appetite, inability to control emotions, nightmares, clinginess, whining
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9
Q

subjective observations

A
  • postural alignment
  • skin
  • respiratory system
  • what muscles are working/imbalances
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10
Q

Postural alignment

A

-rib cage position
-rib spacing
-shoulders
-sternum
-spine
-pelvis

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11
Q

By what age is a Childs rib cage most like that of an adult

A

7-8 years old

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12
Q

**see comparison of infant to adult chest

A
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13
Q

Normal Chest development of an infant

A

➢ ⅓ of trunk
➢ triangular
➢ short neck
➢ flared ribs
➢ obligatory belly breather (using
diaphragm)
➢ narrow intercostal
space

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14
Q

Normal chest development - adult

A

● > ½ trunk cavity
● Rectangular shape
● Wide upper chest
● Lower ribs
integrated with
abdominals
● Wide intercostal
spacing

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15
Q

Children with CP often have:

A

●Chest high (elevated) (weak abs)
●Chest flattened anteriorly
●Rib flaring
● Small intercostal space

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16
Q

What is a common characteristic of
the rib cage of a child who presents
with hypotonia, such as a child
diagnosed with Down Syndrome?

A

Rib flaring

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17
Q

reviewing the integumentary system?

A
  • Color
  • Scars
  • Nail beds
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18
Q

White or bluish tint around mouth
may indicate?

A

Cyanosis

19
Q

Is breathing pattern the same for children of all ages?

A

no

20
Q

When is abdominal breathing present?

A

birth

21
Q

abdominal/thoracic breathing

A

present at 6-8
months when a child can: sit up against
gravity, actively rotate trunk, actively extend
trunk

22
Q

When do children progress to adult breathing pattern

A

8 years old

23
Q

Adult respiratory pattern

A
  • chest dominant
  • diaphragm dominant
  • combination/even
  • anterior/ lateral/ posterior chest
24
Q

What/How are muscles working in adult breathing pattern?

A
  • quick/ abrupt initiation
  • dominance
  • balance
25
Q

Intercostals

A

stabilize rib cage during inhalation to prevent chest wall
from being sucked in (paradoxical breathing) by negative pressure

26
Q

External Intercostals

A

active during quiet and force inhalation

27
Q

Internal Intercostals

A

forced exhalation

28
Q

diaphragm

A

contracts and flattens during inhalation then relaxes to push
air out of lungs during exhalation

29
Q

Abdominals

A

give dynamic stability

30
Q

Objectives measures

A
  1. Vitals: HR and RR
  2. FEV-forced expiratory function
  3. IV-inspiratory function
  4. Phonation
  5. Cough
  6. ROM: shoulder, trunk, hips, pelvis
  7. Thoracic expansion
  8. Pectus excavatum measurement
  9. Endurance
31
Q

How to take HR

A

● Take after child has sat quietly for 5 minutes
● Take during last 10 seconds of walking
● Heart rate monitors
● Pulse oximeters

32
Q

Heart rate has been shown to be…

A

an accurate
and convenient estimate of energy
expenditure

33
Q

Child Considerations

A

●Respiratory rate
●Forced expiratory volume
●Inspiratory volume
●Phonation
●Cough effectiveness
● Thoracic expansion

34
Q

Premature infant HR and RR

A

HR: 120-180
RR: 60-80

35
Q

New born HR and RR

A

HR: 120-160
RR: 40

36
Q

Infant HR, BP, RR

A

HR: 100-140
BP: 80-40
RR: 30-40

37
Q

Child HR, BP, RR

A

HR: 80-120
BP: 100/60
RR: 25-30

38
Q

What is spirometry indicative of?

A

diagnosing respiratory disease

39
Q

Testing Phonation

A
  • 8-10 syllable phrase
  • “How much is that doggy in the window”
  • Timed “ah” or “oh” for 10-12 seconds
40
Q

Coughing

A
  1. Can the child cough?
  2. What is the quality, strength of cough?
  3. Do you see three phases: inhalation, thoracic pressure, forced exhalation?
41
Q

Review assisted coughing

A
42
Q

What are developmental considerations when examining thoracic expansion?

A
  • Axilla
  • Xiphoid
  • Lowest rib (halfway between xiphoid and umbilicus)
43
Q

Measures of Endurance

A

● Treadmill
● Bike
● 6 minute walk test
● TUDST
● HR
● EEI
● Functional measures?

44
Q

energy expenditure index

A

Method to quantify and compare walking
energy expenditure for children and
adolescents

Peds Neuro (19 decks)

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